What Is Tokophobia? New Survey Finds Majority of US Women Have a Fear of Childbirth

Childbirth, a momentous and transformative event, is often regarded with a mix of excitement and trepidation. However, for many women in the United States, childbirth triggers an extreme and debilitating fear known as tokophobia. This fear, exacerbated by the challenges of the COVID-19 pandemic, has recently come to the forefront of maternal mental health research, revealing alarming prevalence rates and a pressing need for more comprehensive care. In this in-depth exploration, we delve into the phenomenon of tokophobia, its underlying factors, and the critical importance of addressing it as an integral component of maternal care.

Tokophobia Unveiled: A Fear Beyond the Norm

Tokophobia, the extreme fear of childbirth, distinguishes itself from the typical anxieties and concerns that can accompany pregnancy. While it is natural for expectant mothers to experience varying levels of worry or fear regarding pregnancy and birth, tokophobia represents an extreme end of this spectrum.

Sharon Ben-Rafael, PsyD, a licensed clinical psychologist specializing in prenatal mental health, explains, “Most women experience some level of worry or fear before birth. If we were to place these worries and fears on a continuum, tokophobia would be at the extreme end.”

Despite its significant impact on maternal well-being, tokophobia has remained relatively understudied within the United States. Unlike in countries such as those in Scandinavia, where screenings for tokophobia are considered standard care for pregnant individuals, comprehensive research on this mental health condition within the U.S. has been limited.

A Glimpse into the Research: High Rates and Disparities

In April, a study published in “Evolution, Medicine, and Public Health” provided fresh insights into tokophobia within the U.S. context. The study, conducted by Dartmouth researchers, sought to identify the factors contributing to a fear of childbirth and examine how the COVID-19 pandemic influenced tokophobia rates.

Zaneta Thayer, PhD, the lead author of the study and an associate professor of anthropology at Dartmouth College, emphasized the study’s findings, stating, “Our results showed really high rates of childbirth fear in our sample.”

It’s important to note that the absence of pre-pandemic U.S. data for comparison makes direct assessments challenging. However, the study’s findings align with international studies conducted before the pandemic, indicating that tokophobia is highly prevalent among pregnant individuals.

Significantly, the study also uncovered disparities in tokophobia rates among various demographic groups. Black individuals, those with lower household incomes, and individuals with lower levels of education were more likely to experience a fear of childbirth. This disparity sheds light on the broader issue of health inequities within the U.S. healthcare system, particularly concerning maternal care.

The Pandemic Effect: Tokophobia Exacerbated

The study was conducted during the first ten months of the COVID-19 pandemic, a period marked by lockdowns and immense stress on the healthcare system. These extraordinary circumstances undoubtedly contributed to the heightened levels of tokophobia observed.

Thalia Robakis, MD, PhD, an associate professor of psychiatry at Icahn School of Medicine and co-director of Mount Sinai’s Women’s Mental Health Program, noted that the fear experienced by expectant mothers during this time was rational given the exceptional circumstances. Concerns related to the potential impact of COVID-19 on the health of the baby or the possibility of being separated from the newborn if a parent tested positive added to the anxiety. The lockdowns further exacerbated fears as they limited the expected support from friends and family.

The Consequences of Tokophobia: Impact on Birth Outcomes

Understanding the far-reaching implications of tokophobia is crucial. The study revealed that pregnant individuals who experienced tokophobia were 91% more likely to have a preterm birth, occurring before the 37th week of pregnancy. While birth weight did not appear to be significantly affected, the fear of childbirth can influence the progression, duration, and outcomes of labor.

Dr. Robakis explains, “When the fear response is triggered during labor, it may affect progression, length, and delivery outcomes.” It is important to note that more research is needed to comprehensively explore how and why tokophobia impacts birth outcomes. However, existing research suggests that maternal stress, in various forms, can affect gestational length and other aspects of pregnancy, with potential long-term consequences for the child’s development.

Moreover, tokophobia can shape decisions regarding medical care during childbirth, potentially leading to interventions like elective cesarean sections. Therefore, timely recognition and management of tokophobia are imperative to ensure both maternal and fetal well-being.

Addressing Tokophobia: A Step Towards Equitable Maternal Care

The high prevalence of tokophobia in the U.S. is reflective of the existing healthcare disparities faced by expectant parents, a fact not lost on experts in the field. Dr. Robakis emphasizes that the absence of a national public health insurance system in the U.S., coupled with the absence of mandated paid maternity leave, places significant financial strain on new parents.

Furthermore, health inequities, including racial disparities in obstetric care for Black mothers, contribute to the high rates of tokophobia among historically underrepresented groups. Statistically, minority individuals face a higher risk of birth-related deaths, with Black women being three times more likely to die from a pregnancy-related cause than white women. Limited access to healthcare resources, a lack of insurance coverage, and systemic racism within the healthcare system create a substantial divide in available support.

Addressing tokophobia within the U.S. healthcare system begins with recognizing the need for standardized screening and treatment as part of routine maternal care. Previous research has shown that managing childbirth fear can alleviate symptoms and increase confidence in one’s ability to give birth. Conducting further research on fear of childbirth within the U.S. context will also equip healthcare providers with valuable insights into care and treatment options.

In the meantime, individuals who identify a strong fear of childbirth should initiate a conversation with their physician. Healthcare professionals can provide assistance or recommend resources, including cognitive behavioral therapy (CBT), which has proven effective in managing tokophobia.

As Dr. Robakis aptly summarizes, “Trepidation about childbirth is very common, but individuals should consider seeking treatment if the fear becomes impairing.” By recognizing and addressing tokophobia, the U.S. healthcare system can take a significant step toward enhancing maternal care and promoting equitable access to support for all expectant parents.